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Comparison of delirium assessment tools in a mixed intensive care unit.
Crit Care Med. 2009 Jun; 37(6):1881-5.CC

Abstract

OBJECTIVE

Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).

DESIGN

Prospective study.

SETTING AND PATIENTS

During an 8-month period, 126 patients (mean age 62.4 years, sd 15.0; mean Acute Physiology and Chronic Health Evaluation II score 20.9, sd 7.5) admitted to a 32-bed mixed medical and surgical ICU were studied.

MEASUREMENTS

The included patients were assessed independently by trained ICU nurses using either the CAM-ICU or the ICDSC. Furthermore, the ICU physician was asked whether a patient was delirious or not. A psychiatrist, geriatrician, or neurologist serving as reference rater diagnosed delirium using established criteria.

MAIN RESULTS

The CAM-ICU showed superior sensitivity and negative predictive value (64% and 83%) compared with the ICDSC (43% and 75%). The ICDSC showed higher specificity and positive predictive value (95% and 82% vs. 88% and 72%). The sensitivity of the physicians view was only 29%.

CONCLUSIONS

ICU physicians underdiagnose delirium in the ICU, which underlines the necessity of standard evaluation in all critically ill patients. In our mixed ICU population, the CAM-ICU had a higher sensitivity than the ICDSC.

Authors+Show Affiliations

Department of Intensive Care, University Medical Center Utrecht, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19384206

Citation

van Eijk, Maarten M J., et al. "Comparison of Delirium Assessment Tools in a Mixed Intensive Care Unit." Critical Care Medicine, vol. 37, no. 6, 2009, pp. 1881-5.
van Eijk MM, van Marum RJ, Klijn IA, et al. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med. 2009;37(6):1881-5.
van Eijk, M. M., van Marum, R. J., Klijn, I. A., de Wit, N., Kesecioglu, J., & Slooter, A. J. (2009). Comparison of delirium assessment tools in a mixed intensive care unit. Critical Care Medicine, 37(6), 1881-5. https://doi.org/10.1097/CCM.0b013e3181a00118
van Eijk MM, et al. Comparison of Delirium Assessment Tools in a Mixed Intensive Care Unit. Crit Care Med. 2009;37(6):1881-5. PubMed PMID: 19384206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of delirium assessment tools in a mixed intensive care unit. AU - van Eijk,Maarten M J, AU - van Marum,Rob J, AU - Klijn,Ine A M, AU - de Wit,Nelleke, AU - Kesecioglu,Jozef, AU - Slooter,Arjen J C, PY - 2009/4/23/entrez PY - 2009/4/23/pubmed PY - 2009/6/9/medline SP - 1881 EP - 5 JF - Critical care medicine JO - Crit Care Med VL - 37 IS - 6 N2 - OBJECTIVE: Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician). DESIGN: Prospective study. SETTING AND PATIENTS: During an 8-month period, 126 patients (mean age 62.4 years, sd 15.0; mean Acute Physiology and Chronic Health Evaluation II score 20.9, sd 7.5) admitted to a 32-bed mixed medical and surgical ICU were studied. MEASUREMENTS: The included patients were assessed independently by trained ICU nurses using either the CAM-ICU or the ICDSC. Furthermore, the ICU physician was asked whether a patient was delirious or not. A psychiatrist, geriatrician, or neurologist serving as reference rater diagnosed delirium using established criteria. MAIN RESULTS: The CAM-ICU showed superior sensitivity and negative predictive value (64% and 83%) compared with the ICDSC (43% and 75%). The ICDSC showed higher specificity and positive predictive value (95% and 82% vs. 88% and 72%). The sensitivity of the physicians view was only 29%. CONCLUSIONS: ICU physicians underdiagnose delirium in the ICU, which underlines the necessity of standard evaluation in all critically ill patients. In our mixed ICU population, the CAM-ICU had a higher sensitivity than the ICDSC. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/19384206/Comparison_of_delirium_assessment_tools_in_a_mixed_intensive_care_unit_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181a00118 DB - PRIME DP - Unbound Medicine ER -